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Interview with Charlotte Monro, Chair of Unison, Waltham Forest Health Branch
WDIE: What is being planned for Whipps Cross hospital, and how is it being decided?
CM: The hospital authorities are looking to "save" £33 million, mostly this year and next year. At the moment, the plan put forward includes cutting 107 beds, which means around five wards. They have already shut two, and are about to close a third, and a second care of the elderly ward in December, i.e. a fourth ward. Yesterday the hospital was on red alert which means there are hardly any empty beds and people waiting to be admitted in A&E.
There are other cuts which will impact on patients. They are planning to shut two theatres. They have shut eight maternity beds and are talking about shutting another eight in a department that is under pressure and in a borough which has the highest infant mortality rate in London. The PCT holds the money, and they have commissioned for 17,303 fewer appointments at outpatients, which include follow up and at least 6,000 first appointments. There is a lot of concern in those departments about what is happening to patients. There are supposed to be some measures in place in the primary care services, such as specialist GPs. There are concerns that some people may not be accessing the specialist care they need, and others have to come to the hospital departments as a second appointment for specialist referrals introducing long delays in treatment.
Whipps Cross is now saying that the number of staff who are currently working at the hospital who will be made redundant is 276. This includes nursing staff, and a large number of admin and clerical staff.
Whole departments are being disestablished, such as Property Services, part of estates which deal with major building projects and the hospital redevelopment team.
The drive is coming from the government in terms of the changes to the financial rules, with "Payment by Results", and cuts to the PCT budget which then commissions less and therefore pays less to the general hospital. For years, Whipps Cross has been under-funded for the work that it does. Unlike in previous years where spending restrictions and various accounting methods were used to muddle through till the next financial year, the government is now insisting that every bit of "overspend" is exposed, previous accounting methods are not allowed, and there is a directive from the DoH and the strategic health authority to cut back the hospitals capacity to meet the budget which is given them. So the hospital is being expected to cut the work it does for patients and the resources it has to do that work to meet a budget which bears no relation to the health care needs of the local population.
How the decisions work is that the trust board puts forward its proposals, and that goes up to the London-wide strategic health authority called London Health, which has taken over from North East London, and is huge. They are the ones which seem to be taking the decisions. But we also have a turn-around director at Whipps Cross who has been here since May, at a cost of £1,200 a day, a business consultant from the private sector, who appears to have a significant amount of power within the organisation, and has actually been given executive powers. There is also a turn-around director for London Strategic Health Authority.
The pressure on staff is intense both from the point of view of the stress and threat of redundancy, the general increasingly threatening atmosphere and culture within the hospital, and in terms of an enormous pressure of workload. Especially in the back office area the support areas, such as medical secretaries, patient records and pathology vacancies have been frozen and staff are expected to cover significantly increased workloads. People say they can pull out the stops for a day, but in the longer term they are totally exhausted, so there is concern for peoples health and concern for the clinical impact on patients. The fear is that the trust expects the consolidation of this pace of work into normal working so as to justify the redundancies; in other words, there is a huge intensification of exploitation of health workers.
The hospital support workers porters, domestics, switchboard staff who are employed by private contractors, have already had cuts in hours and pay, and have had redundancies imposed on them. Their employer, Initial Hospital Services, is refusing to implement a pay agreement to bring pay and conditions equal to the NHS, which should have been implemented from April this year.
WDIE: What has been the response of the health workers and other hospital staff, and what actions have been organised?
CM: The response of staff has been anger, coupled at the same time with the feeling of being under threat and trying to cope with an atmosphere of intimidation. All the unions representing staff at Whipps Cross are opposed to any compulsory redundancies. The community needs our services, and it is outrageous to be making health care staff, whose services are need in the community and have long experience in delivering health care and organising the hospital, the target of redundancies. Everyone is under a lot of pressure.
People are challenging individual decisions, some successfully. We have had very well attended meetings of staff organised by the unions, we have published newsletters and very early on strong campaigns started in the community. Waltham Forest Trades Council joined with health workers in setting up a community campaign. Hospital workers and health workers in the community employed by the PCT have joined forces with people from the community who are or have been patients to launch a campaign to defend local health services. We have affiliated to the national Keep the NHS Public Campaign.
On July 1, a demonstration of 200 people assembled outside the gates of Whipps Cross Hospital to march to the Walthamstow Market Square for a rally. The demonstration was applauded as it marched through the streets, with some people joining the demonstration as it passed by.
Different groups who are campaigning have held three or four public meetings during the course of the struggle. Waltham Forest Keep Our NHS Public Campaign meets regularly.
The campaign has called a lobby of the Trust Board meetings and members of the public have challenged them on the future of the hospital, the impact on staff and patients and the shutting of the wards.
The support workers have held three strikes and are planning a further three-day strike soon.
WDIE: How is the campaign going and what is the sentiment of the hospital staff and the local community?
CM: One of the early successes of the campaign was to force Waltham Forest Primary Care Trust to drop proposals which would have decimated community nursing services, cutting health visitors and school nurses by 45% and district nurses by 22%. These were opposed by the professionals involved, mothers and families relying on the service, and the broader community as well as the health scrutiny committee of the local council. The proposals were dropped because of the opposition.
However, these services are still under serious pressure because the PCT is trying to "save" £1.5 million from community nursing by vacancy freezes and other means as part of £50 million cuts.
The campaign has been sustained with regular meetings of activists sharing information and planning activities. They have been getting information out to the public through Saturday stalls in the local market, leafleting and gathering signatures on petitions.
There is no public consultation on these cuts and very little information getting to people other than through the campaign. When people learn of what is happening to their health service, they are very concerned and quite incredulous. A very serious concern that has developed is that it is becoming clear that the very future of Whipps Cross Hospital may be uncertain. A London Strategic Health Authority paper is looking at reconfiguration of the health service in outer northeast London. This paper asserts that there are too many in-patient beds in the region, and provision must be brought in line with existing funding and the new NHS financial rules. On the long list of options currently under consideration, the downgrading of either Whipps Cross Hospital or King Georges Hospital in Ilford or both from being acute district general hospitals to ambulatory or intermediate care centres is one of the options.
Hospital officials are denying that there is any plan to close Whipps Cross. But people across both hospital and community are outraged that any concept of downgrading the hospital could be considered. Whipps Cross has one of the busiest A&E departments in the country, and it serves a community which has a very high level of health needs and social deprivation. We need a fully funded, fully functioning district general hospital, and people will fight for that.
WDIE: What has been the response of the hospital trust board?
CM: The boards response has been to assert that there are no plans which threaten the future of the hospital. Their position is that £33 million of cuts can be achieved without affecting patient care! If they had to make the further cuts that the Strategic Health Authority is requiring, they acknowledge that this is unlikely to be achieved without a significant impact on services the hospital delivers, but they are asserting they can deliver the rest without an impact.
They are quite keen to avoid redundancy costs where they can and avoid large numbers of redundancies of clinical staff. They have acceded to some of the concerns and demands of the unions, but they are trying to implement the key issues of cutting back on wards, cutting back on services and making staff redundant, as quickly as possible.
Vacancies have been frozen for several months and use of agency staff banned in non-clinical areas. Many departments have been trying to cope on very reduced staffing levels. One consequence is that patient notes are not being processed for appointments, because they are stacking up on office floors, and in cages where they are stored in transition, creating health and safety risks for staff and becoming inaccessible when needed for clinical appointments, admissions, operations, and so on. The vacancy freezes are tied in to plans to reduce staffing levels permanently and make existing staff redundant.
WDIE: Is the campaign linking up with other struggles to defend health care?
CM: Yes, it is linked with Keep the NHS Public. There have been London-wide meetings which a number of us have attended with people in similar situations to us and we are sharing experiences. The main thing we are focusing on in the London group is to develop London-wide actions in conjunction with the unions, together with national action.
WDIE: Can you say how the struggle relates to the governments plan for the NHS?
CM: There are two questions which are actually key how is funding for health decided and on what basis are these decisions made. Every decision under discussion is within the framework of accepting the financial cuts dictated. Everything has to start from that framework. That is what the government is trying to dictate. However, the real question is, what are the health needs of the local population in different areas and across the nation, and what is the nature of the services that need to be invested in and developed to meet those needs with the most up-to-date knowledge that we have in the health service. This is the real agenda that the campaigns need to be raising in opposition to the governments agenda.
WDIE: How do you see the struggle in relation to the right to health care and a health service of the future which meets the peoples needs?
CM: It is absolutely critical. The health service has never been under such fundamental threat. Activists and most health workers are very clear that the governments agenda is privatisation, and the financial restrictions and the cuts are part of a strategy to reduce NHS capacity in order to open more space for the private sector, and to put the financial system into place that will compatible with private business within health care.
The other issue is how health care should be provided by multinationals whose aim is to make as much profit as they can out of the system, or should it be provided by the society as a public service? This has a very real impact in terms of access to health care. But we are also experiencing now a battle on the front of culture and ethos within the health service.
WDIE: How can people support your struggle?
CM: By getting involved in the campaign, by writing letters, by relating actual experiences and making sure that the campaign and the unions are aware of impacts of the policy, by contributing their views on how the health service should be run, what should be provided and what the priorities should be, by building networks, getting information out to people to their friends, workmates, neighbours. There is campaign organising meeting on Monday, September 4, 7.30pm, Quaker Meeting House, Jewel Road (off Hoe Street), Walthamstow, E17. On October 14, there will be a lobby of the Waltham Forest Health Scrutiny Committee of the local council, at which Whipps Cross is on the agenda.
WDIE: Is there anything else you would like to add?
CM: I would like to highlight also the struggle of the hospital support workers which I mentioned earlier. Their full story deserves to be known, and the solid turnout in the strikes they have held so far shows how seriously they take their rights and their dignity. Their struggle is one that calls for support.
WDIE: Thank you very much.
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